Florida’s Property Insurance Claim Process Laws

Florida’s Property Insurance Claim Process Laws

Below is a list of laws that govern the conduct of property insurance claims in the state of Florida. This list is not meant to be comprehensive, only to provide an overview of the protection and guidance the law affords:F.S. §624.155(1)(a)1– Any person may bring a civil action against an insurer when such person is damaged: (a) by violation of any of the following provisions by the insurer: (1) Section 626.9541(1)(i), (o), or (x)

F.S. §624.155(b)1 – Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward the insured and with due regard for her or his interests.

F.S. §624.155(b)2 – Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.

F.S. §624.155(b)3 – Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.

F.S. §626.9541(1)(i)1 – Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.

F.S. §626.9541(1)(i)2 – A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.

F.S. §626.9541(1)(i)3a – Failing to adopt and implement standards for the proper investigation of claims.

F.S. §626.9541(1)(i)3c – Failing to acknowledge and act promptly upon communications with respect to claims.

F.S. §626.9541(1)(i)3d – Denying claims without conducting reasonable investigations based upon available information.

F.S. §626.9531(1)(i)3e – Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.

F.S. §626.9541(1)(i)3f – Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.

F.S. §626.9541(1)(i)3g – Failing to promptly notify the insured of any additional information necessary for the processing of a claim.

F.S. §626.9541(1)(i)3h – Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.

69O-220.201(4) – The work of adjusting insurance claims engages the public trust. An adjuster must put the duty for fair and honest treatment of the claimant above the adjuster’s own interest, in every instance.

69O-220.201(4)(a) – An adjuster shall disclose all financial interest in any direct or indirect aspect of an adjusting transaction.

69O-220.201(4)(b) – An adjuster shall treat all claimants equally. An adjuster shall not provide favored treatment to any claimant. An adjuster shall adjust all claims strictly in accordance with the insurance contract.

69O-220.201(4)(c) – An adjuster shall never approach investigations, adjustments, and settlements in a manner prejudicial to the insured.

69O-220.201(4)(d) – An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.

69O-220.201(4)(e) – An adjuster shall handle very adjustment and settlement with honesty and integrity and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled.

69O-220.201(4)(f) – An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition thereof.

69O-220.201(4)(g) – An adjuster shall promptly report to the Office any conduct by any licensed insurance representative of this state, which conduct violates any insurance law or Office rule or order.

69O220.201(4)(h) – An adjuster shall exercise extraordinary care when dealing with elderly clients, to assure that they are not disadvantaged in their claims transactions by failing memory or impaired cognitive processes.

69O-220.201(4)(i) – An adjuster shall not negotiate or effect settlement directly or indirectly with any third party claimant represented by an attorney, if said adjuster has knowledge of such representation, except with the consent of the attorney. For purposes of this subsection, the term “third party claimant” does not include the insured or the insured’s resident relatives.

69O-220.201(4)(j) – An adjuster is permitted to interview any witness, or prospective witness, without the consent of opposing counsel or party. In doing so, however, the adjuster shall scrupulously avoid any suggestion calculated to induce a witness to suppress or deviate from the truth, or in any degree affect their appearance or testimony at the trial or on the witness stand. If any witness making or giving a signed or recorded statement so requests, the witness shall be given a copy thereof.

69O-220.201(4)(k) – An adjuster shall not advise a claimant to refrain from seeking legal advice, nor advise against the retention of counsel to protect the claimant’s interest.

69O-220.201(4)(l) – An adjuster shall not attempt to negotiate with or obtain any statement from a claimant or witness at a time that the claimant or witness is, or would reasonably be expected to be, in shock or serious mental or emotional distress as a result of physical, mental or emotional trauma associated with a loss. Further, the adjuster shall not conclude a settlement when such settlement would be disadvantageous or to the detriment of a claimant who is in the traumatic or distressed state described above.

69O-220.201(4)(m) – An adjuster shall not knowingly fail to advise a claimant of their claim rights in accordance with the terms and conditions of the contract and of the applicable laws of this state. An adjuster shall exercise care not to engage in the unlicensed practice of law as prescribed by the Florida Bar.

69O-220.201(4)(n) – A company or independent adjuster shall not draft, unless approved in writing in advance by the insurer and such written communication can be demonstrated to the Office, special releases called for by the unusual circumstances of any settlement or otherwise draft any form of release. Except as provided above, a company or independent adjuster is only permitted to fill in the blanks of a release form approved by the insurer they represent.

F.S. §626.878 – An adjuster shall subscribe to the code of ethics specified in the rules of the Department (formerly the Department of Insurance).

F.S. §626.877 – Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state.